Why it’s time this specialty got more attention

There are few specialties that give as many opportunities as obstetrics and gynaecology. Trainees work as both surgeon and physician, caring for two lives at the same time. It includes many different disciplines, such as endocrinology, sexual health, pharmacology, psychology, pathology and neonatology.

It is often described as a surgical art. Doctors work with midwives and other health professionals to deliver babies while putting their experience in preventative medicine to the ultimate test by delivering potentially lifesaving antenatal care.

Obstetrics and gynaecology has developed enormously over the last 30 years. Yet despite the numerous advances in this field and the huge potential for growth, recruitment numbers have in the past been small.

Things could be looking up, however. More consultant posts are being created, and more medical students are drawn to the specialty. Obstetrics and gynaecology was one of the first specialties to devise a structured training programme, community gynaecology is growing, and there is more flexibility in training opportunities in clinical and academic obstetrics and gynaecology than ever before.

Meet an obstetrician and gynaecologist: Dr Melissa Whitten

I first became interested in O&G when I was a medical student. On my placement I helped deliver babies, so it was this challenge and the sense of amazement in the labour ward that first attracted me. I liked surgery, medicine and psychiatry, and O&G brings these specialties together. As a trainee, I was fortunate to work in a number of different units with a wide variety of experience, and great colleagues. As a consultant, I leave work each day with a sense of achievement because I’m working in a specialty that I think that I can make a difference in.

It is possible to have a life outside this specialty. Flexible working patterns are common in O&G. It’s an acute specialty, so there is night and weekend work, but like all specialties this is governed by working time regulations to keep it in proportion. Most trainees at my hospital either work one weekend a month or work days or nights. As a consultant, I work on average 1 night every 8 days during the week, and 1 weekend every 2 months where I am on call for the whole weekend. I work with a team of junior doctors and midwives both during the normal working week and on call.

The biggest challenge I’ve encountered in my career so far is working for a huge organisation like the NHS. Capacity, logistical and organisational issues can sometimes encroach on how you spend your days at work. For example, a woman who goes into premature labour when the neonatal unit is already full and there aren’t any neonatal unit cots available within 100 miles means spending three hours on the phone trying to find a bed.

A different challenge can be dealing with decision making where ethical issues are involved. For instance when a scan reveals an abnormality, discussing the options with the parents and determining what is ‘normal’ can be a struggle. It can also be difficult when there is a baby at risk of a poor outcome, and where the course of action you advise is at odds with what the parents want.

In the past, about 4% to 5% of medical graduates would go into obstetrics and gynaecology, but this has fallen during the last few decades. This seems to have been down to common misconceptions about disadvantaged male doctors, heavy night-time work commitments and the fear of litigation.

There is some evidence that female patients undergoing a pelvic examination will be more likely to decline assistance from male students than female students. Unfortunately men can come away from this with the misconception that they won’t be able to treat patients if they go into O&G. But it can be a fulfilling career for all genders, and a lot of work has been done in recent years to support student experience in O&G. We hope that this encourages more students to consider it as a career.

My advice for aspiring obstetricians and gynaecologists:

• Talk to your local trainees and tutors
• Work on developing good communication skills, as there is a lot of communication work within this field
• Do a foundation module in women’s health
• Get involved in relevant audits or project work
• Register with the RCOG as a junior affiliate to get information and support when applying for jobs.